in an Era of Health Reform Presented by: Jean Moore, DrPH Director - - PowerPoint PPT Presentation

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in an Era of Health Reform Presented by: Jean Moore, DrPH Director - - PowerPoint PPT Presentation

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Physician Supply and Demand in an Era of Health Reform Presented by: Jean Moore, DrPH Director Center for Health Workforce Studies School of Public Health | University at Albany, SUNY jean.moore@health.ny.gov www.chwsny.org/ Symposium on

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Presented by: Jean Moore, DrPH Director Center for Health Workforce Studies School of Public Health | University at Albany, SUNY jean.moore@health.ny.gov www.chwsny.org/

Symposium on Physician Workforce

Greater New York Hospital Association Associated Medical Schools of New York October 14, 2016

Physician Supply and Demand in an Era of Health Reform

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The Center for Health Workforce Studies at the University at Albany, SUNY

  • Established in 1996
  • A center of the UAlbany School of Public

Health

  • Committed to collecting and analyzing data to

understand workforce dynamics and trends

  • Goal to inform public policies, the health and

education sectors and the public

  • Monitors the state’s health workforce,

including physicians and GME outcomes

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www.chwsny.org

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Today’s Presentation

  • Health care delivery transformation
  • Impacts of health reform on health workforce
  • Workforce issues and challenges
  • Data and information on the state’s physicians
  • Looking ahead
  • Roles of UME/GME educators

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www.chwsny.org

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The Changing Health Care Landscape

Goals of health reform

  • To increase access to basic health care

services

  • To provide high quality, cost-effective

care

  • To improve population health

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www.chwsny.org

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What Changes With Health Reform?

  • Shift in focus away from acute care to primary

and preventive care

  • Service integration: primary care, behavioral

health and oral health

  • Better coordinated care
  • Payment reform, moving away from fee-for-

service and toward value-based payment

  • incentives for keeping people healthy and

penalties for poor outcomes, eg, inappropriate hospital readmissions

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www.chwsny.org

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New York’s Health Reform Programs

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  • Provider incentive payments based on project

milestones and outcomes; Value Based Payment

  • Range of payment models, unique to payers but

aligned across them, including P4P, shared savings, capitation, etc.

Scope

  • All providers that qualify as Safety Net providers, along

with coalitions (PPS) of other proximate providers

  • All Medicaid patients attributed to those coalitions
  • All primary care practices
  • All payers
  • All New Yorkers

Delivery System Reform Incentive Payment (DSRIP) Program State Health Innovation Plan (SHIP) State Improvement Model Goals

  • Large-scale reform of the delivery system accountable

for safety net patients

  • 25% reduction in avoidable hospital use over 5 years
  • Integrated, value-based care through population health-

based care delivery models and payment innovation

  • 80% of New Yorkers impacted within 5 years

Units

  • Provider Performing Systems (PPSs)
  • Primary care practices (of any size or affiliation)

Payment models

www.chwsny.org

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Workforce Implications of Health Reform

  • New models of care are increasing in number

(Patient Centered Medical Homes, Accountable Care Organizations, Preferred Provider Systems)

  • Team-based approaches to care are frequently

used in these models

  • Team composition and roles vary, depending on

the patient population

  • Teams may include: physicians, NPs, PAs, RNs,

social workers, LPNs, medical assistants, and community health workers, among others

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www.chwsny.org

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Multidisciplinary Teams Shown to Have Positive Impacts on Patient Outcomes

  • “The provision of comprehensive health services to patients

by multiple health care professionals with a collective identity and shared responsibility who work collaboratively to deliver patient-centered care.”

Source: Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

  • Research suggests health care teams with greater

cohesiveness and collaboration are associated with:

  • Higher levels of patient satisfaction
  • Better clinical outcomes
  • The most effective and efficient teams demonstrate a

substantial amount of shared responsibility (scope overlap)

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www.chwsny.org

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So What’s the Problem?

  • Maldistribution of available health workforce

capacity

  • Health professions education students are not

consistently exposing students to team-based models of care or trained in emerging functions

  • Scope of practice restrictions
  • Health professionals not always allowed to do what

they are trained and competent to do

  • Shared responsibility (scope overlap) needed for team-

based care is challenging to achieve

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www.chwsny.org

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Primary Care HPSAs in New York State

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www.chwsny.org

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Primary Care Health Professional Shortage Areas in New York City

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www.chwsny.org Source: Center for Health Workforce Studies

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Are We Training the Future Health Workforce for Team-based Practice?

  • Health professions education typically occurs in

disciplinary siloes

  • The focus on specialized clinical roles can

interfere with team delegation and collaboration

  • Doctors, nurses, and others get little guidance
  • n how to interact effectively with each other

in support of team care

  • There’s limited exposure to emerging models
  • f care that demonstrate use of group-based

decision making

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www.chwsny.org

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Are We Training the Health Workforce for Emerging Functions?

  • Effective chronic disease management
  • Patient engagement
  • Health coaching
  • Motivational interviewing
  • Care coordination
  • Population health
  • Data analytics

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www.chwsny.org

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Data and Information on the State’s GME Outcomes

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www.chwsny.org

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GME in the U.S. and New York

  • In the U.S., nearly 9,700 programs with more

than 118,000 residents

  • 37 physicians in training per 100,000

population

  • In New York, over 1,100 programs with more

than 16,000 physicians in training

  • 81 physicians in training per 100,000

population

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www.chwsny.org

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The New York Resident Exit Survey

  • A survey of all residents and fellows completing

training in New York (more than 5,000 annually)

  • Conducted annually since 1998 (except 2004 and

2006)

  • Substantial assistance from GME program

directors

  • Average annual response rate of 61%
  • Cumulative number of responses: 47,905

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www.chwsny.org

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14% of Survey Respondents Were Under-represented Minorities

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Percentage of Underrepresented Minorities by Specialty Group 2015 Resident Exit Survey, CHWS

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Relative Demand by Individual Specialty

  • Highest Relative Demand
  • Family Medicine
  • Emergency Medicine
  • Psychiatry
  • Dermatology
  • General Internal Medicine
  • Lowest Relative Demand
  • Pathology
  • Radiology
  • Pediatric Subspecialties
  • Anesthesiology
  • Cardiology

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www.chwsny.org

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Less Than Half of Newly Trained Physicians Plan to Stay in New York to Practice

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www.chwsny.org

2015 Resident Exit Survey, CHWS

In-State Retention of Physicians Completing GME Training in New York

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In-State Retention of All Physicians and Primary Care Physicians Who Trained in New York

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2015 Resident Exit Survey, CHWS

www.chwsny.org

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Increasing Percentage New Primary Care Physicians Entering Practice in New York

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www.chwsny.org

Percentage Of New Physicians Entering Practice in New York by Specialty Group

2015 Resident Exit Survey, CHWS

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More New PC Physicians Plan to Work in Inpatient Settings in New York

www.chwsny.org

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Source: Center for Health Workforce Studies

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In-state Retention Higher for New Physicians From New York

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www.chwsny.org 2015 Resident Exit Survey, CHWS

Percentage with Confirmed Practice Plans in New York by Location of High School, Location of Medical School, and Citizenship Status

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Over 25% of New Physicians Leaving New York Cite ‘Proximity to Family’ as a Key Reason

  • When respondents who were planning to

practice outside of NY were asked their main reason for leaving,

  • 28 % - proximity to family
  • 14% - better salary outside New York
  • 13% - better jobs in desired location outside New

York

  • 7% - better jobs in desired setting outside New York
  • 7% - better jobs outside New York that meet visa

requirements

  • 6%- never intended to practice in New York

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www.chwsny.org

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The Changing Focus of Health Workforce Research

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www.chwsny.org

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Health Workforce Research Questions of Interest Are Changing

  • Tended to be profession-specific research: how many?

where? do we have enough?

  • Health reform changed that
  • Shift the focus of the HCDS to primary care and prevention
  • Greater concern with cost, quality, and access
  • Now we ask broader questions: what do patients need;

what are the best workforce strategies to deliver these services?

  • State-specific oral health access issues and potential workforce

strategies

  • Use of telehealth services by providers in New York, barriers

and facilitators

  • Medicaid claims analysis to better understand commuting

patterns for care

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www.chwsny.org

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Who Are New York’s Primary Care Practitioners?

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Percentage of New York’s Physicians, NPs, PAs, and Midwives Who Provide Primary Care Services, 2014

www.chwsny.org

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Are We Growing Our Own Primary Care Practitioners?

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Training Location of Physicians, NPs, PAs, and MWs Who Provide Primary Care in NY

Source: Center for Health Workforce Studies

www.chwsny.org

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Wide Variation in Practice Settings for Primary Care Practitioners

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Practice Settings of New York’s Primary Care Providers, 2014

www.chwsny.org

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Key Workforce Issues

  • Develop strategies to increase the number of

primary care practitioners in the state

  • Better prepare the health workforce for new roles in

emerging models of care

  • Working on teams
  • Ambulatory care, primary care
  • New roles and functions – population health, data

analytics, care coordination

  • Address statutory and regulatory barriers to

effective team-based care

  • Develop strategies to increase access by addressing

workforce maldistribution

www.chwsny.org

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As We Plan for the Future

  • Use data and evidence to inform decisions
  • Build strategic partnerships – providers,

educators, consumers

  • Explore innovative approaches to training

and service delivery

  • Evaluate the impacts of these efforts on

cost, quality and access to care

  • Disseminate what we learn…

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www.chwsny.org

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Thank You

Questions?

Visit Us: www.chwsny.org/

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www.chwsny.org